Provider Demographics
NPI:1144798158
Name:RIZZO, ROSE (LICSW)
Entity Type:Individual
Prefix:
First Name:ROSE
Middle Name:
Last Name:RIZZO
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 WILSON ST
Mailing Address - Street 2:
Mailing Address - City:REVERE
Mailing Address - State:MA
Mailing Address - Zip Code:02151-5330
Mailing Address - Country:US
Mailing Address - Phone:617-240-3302
Mailing Address - Fax:
Practice Address - Street 1:11 WILSON ST
Practice Address - Street 2:
Practice Address - City:REVERE
Practice Address - State:MA
Practice Address - Zip Code:02151-5330
Practice Address - Country:US
Practice Address - Phone:617-240-3302
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-07
Last Update Date:2018-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA221080104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker